Labour Pain: Early Signs, Stages of Labour and When to Go to the Hospital

True labour pain comes as regular contractions that get stronger, longer and closer together and do not stop when you rest, walk or change position. A common rule for a first baby is to go to the hospital when contractions come every 5 minutes, last about a minute, and have continued for at least an hour (the 5-1-1 rule). Go sooner if your waters break, you have bleeding, the baby moves less, or you are before 37 weeks. Labour has three stages: the cervix opens (first stage), the baby is born (second) and the placenta is delivered (third).

This guide explains how to recognise the early signs, the difference between true and false labour, what happens in each stage, when to call your doctor or leave for the hospital and what to pack.

Early signs that labour may be near

These may appear days or hours before true labour starts.

• Lightening: the baby's head settles lower in the pelvis, so breathing becomes easier but you need to pass urine more often and feel pelvic pressure.
• Increased vaginal discharge and a "show": the mucus plug that sealed the cervix comes away as a thick, pink- or blood-streaked jelly-like discharge. Labour may begin within hours or days, or still be a week or more away.
• Loose stools or diarrhoea as the body prepares.
• Nesting urge: a burst of energy to clean and organise.
• Back ache and menstrual-like cramps.
• Braxton Hicks contractions become more frequent.
• Water breaking (rupture of membranes), in about 10 to 15 percent of women before contractions begin.

None of these on its own means labour has started.

True labour vs false labour

| | False labour (Braxton Hicks) | True labour | |---|---|---| | Timing | Irregular, no pattern | Regular and gradually closer together | | Frequency | Do not get closer | Increase over time, from every 10 to 20 minutes to every 3 to 5 | | Duration | Vary, often 30 to 45 seconds | Steadily lengthen to 45 to 90 seconds | | Strength | Weak and often stay the same, or fade | Steadily stronger | | Change with activity | Often stop with rest, walking, a warm bath or changing position | Continue regardless of movement or rest | | Where felt | Mostly in the front of the abdomen, sometimes the groin | Starts in the lower back and wraps around to the front, or the reverse | | Cervix | No change | Opens (dilates) and thins (effaces) | | Show or water breaking | Not typical | Often follows |

If you can talk or walk through the contraction and it passes, it's more likely to be early labour or Braxton Hicks. As it becomes stronger, you won't be able to speak through it.

The stages of labour

First stage: the cervix opens (dilation)

This is the longest stage. It has three phases.

Latent (early) phase. The cervix softens, thins and opens slowly up to about 6 cm. Contractions are mild to moderate, about 5 to 20 minutes apart and 30 to 45 seconds long. Many women stay at home. It can take many hours, especially with a first baby.

Active phase. From about 6 cm to 10 cm. Contractions become strong, every 3 to 5 minutes, lasting 45 to 60 seconds or more. You will want to concentrate, breathe through them and may feel unable to talk. Go to the hospital. For a first-time mother, active labour typically lasts several hours.

Transition. The last stretch to full dilation (8 to 10 cm). Contractions are intense, close together and long. You may feel shivering, nausea, pressure, sweating, irritability or an urge to push. It is short, often 15 to 60 minutes, but the most demanding.

Second stage: pushing and birth

From full dilation (10 cm) until the baby is born. You feel a strong urge to push. The healthcare team will guide you. In a first labour, this stage commonly lasts up to about 3 hours (a little longer with an epidural), and in later births, up to about 2 hours, although it is often much shorter. The baby's head crowns and is born, followed by the shoulders and body.

Third stage: delivery of the placenta

After the baby is born, contractions continue and the placenta separates and is delivered, normally within 5 to 30 minutes. Your doctor checks it is complete and gives medicine (oxytocin) to help the uterus contract and reduce bleeding.

The "fourth stage"

The first hour or two after birth, when you and your baby are monitored closely, skin-to-skin contact is encouraged and breastfeeding can begin.

How long does labour last?

Every labour is different. As a rough guide, for a first baby the whole process from regular contractions to birth often takes 12 to 18 hours or sometimes longer, and for later babies it is often shorter, around 6 to 10 hours. Many women have labours outside those ranges. The latent phase accounts for much of the time, so don't rush to the hospital too early unless advised.

When to call your doctor or go to the hospital

Go to the hospital if:

• Contractions are regular and strong: coming every 5 minutes (or sooner), lasting about a minute, for about an hour (the 5-1-1 rule). Some doctors advise 4-1-1 or going earlier for second and later babies, or if you live far from the hospital or travelling takes a long time in traffic. Follow your own doctor's advice.
• Your waters break, whether as a gush or a steady trickle, even without contractions. Note the time and colour. Go in if the fluid is green or brown (meconium) or has a foul smell, or if you are before 37 weeks. At term, waters breaking without contractions still needs a medical check, since labour usually begins within 24 hours, and the risk of infection rises after that.
• Vaginal bleeding like a period, or more than a "show". Bright red bleeding is not normal.
• Reduced baby movements, or if the baby has stopped moving.
• Constant severe abdominal pain with a hard, tender abdomen, which can signal placental abruption.
• Before 37 weeks, if you have regular contractions, pelvic pressure, leaking fluid or bleeding. This could be preterm labour; go immediately.
• Severe headache, blurred vision, swelling of the face and hands, or pain under the right ribs, which may be signs of pre-eclampsia.
• Fever or a sense that something is wrong.
• High-risk pregnancy: twins, previous caesarean, high blood pressure, diabetes, breech baby, or a low-lying placenta. Your doctor will give you specific advice, and many ask you to come early.

Stay home (for now) if:

• Contractions are irregular, mild and spaced more than 10 minutes apart
• You can talk or walk normally during them
• Your waters are intact, bleeding is absent and the baby is moving normally

While at home in early labour, rest, eat light foods, drink fluids, take a warm shower, walk or change position, time contractions, and call your doctor if you are unsure. No one will mind a call.

Managing labour pain

Without medicines

• Breathing techniques learned in antenatal classes
• Changing positions: walking, swaying, leaning on a birthing ball, hands and knees
• A warm shower or bath (if the doctor allows)
• Massage, especially on the lower back, and counter-pressure
• Having a supportive companion, which is linked with better experiences and outcomes
• Music, quiet and a calm environment
• Heat packs

With medicines

• Epidural analgesia: an injection near the spine that provides effective pain relief. It can lengthen the second stage slightly and may need help with pushing, but is widely used and safe when given by a trained team.
• Other options: nitrous oxide (where available), injectable pain relievers.

Discuss these with your doctor before the due date, and keep an open mind. Birth plans are helpful but things can change.

Birth by caesarean

Some babies are born by caesarean section, planned (for example breech presentation, placenta praevia, previous caesarean, or other medical reasons) or unplanned (if labour does not progress, there is fetal distress or other complications). It's a safe operation when needed. Your team will explain the reasons.

Hospital bag checklist

For you

• Identification, antenatal file, scan reports, blood group card, insurance documents
• Loose, comfortable clothes, nightwear, a front-opening nursing gown or top
• Maternity pads, comfortable underwear
• Nursing bras, breast pads
• Toiletries, slippers, hair ties
• Lip balm, a water bottle, snacks and a phone charger
• Light clothes to go home in

For the baby

• Several sets of soft cotton clothes, caps, mittens and socks
• A swaddle or receiving blankets
• Newborn nappies
• A car seat, if you use one, for the journey home

For your partner or companion

• Snacks, charger, a change of clothes, and a list of contacts

Keep the bag ready by 36 weeks.

What your partner can do

• Learn the signs of labour and the route to hospital in advance, including backup transport and traffic timing.
• Time the contractions and keep notes.
• Stay calm and offer reassurance, water and massage.
• Speak up for your wishes and help communicate with the staff.
• Take care of the paperwork.

Frequently asked questions

What are the first signs of labour?

Regular contractions that intensify, a bloody show, backache and menstrual-like cramps, and water breaking. Lightening and diarrhoea may come before.

How do I know if it's real labour?

Real labour contractions become regular, stronger and closer together and don't ease with rest or a change in position.

When should I go to the hospital for labour?

When contractions come every 5 minutes lasting a minute for an hour, when your water breaks, with bleeding, reduced movements, or before 37 weeks.

What is the 5-1-1 rule?

Contractions every 5 minutes, lasting 1 minute each, for at least 1 hour.

What if my water breaks but I have no pain?

Go to the hospital. Note the time, colour and smell. Labour usually follows within 24 hours, and infection risk rises with time.

How painful is labour?

It varies widely. Many women find it intense. Pain relief options are available, and your care team can help.

Can labour start without pain?

Sometimes labour begins with mild discomfort, backache or just the water breaking. Don't wait for severe pain before calling.

When to see a doctor

Contact your doctor or go to the hospital whenever you are unsure, particularly for fluid leaking, bleeding, reduced baby movements, severe pain, regular contractions before 37 weeks, headache with visual changes or fever.

Care at Prakash Hospital Noida

Whether you live in Sector 18, Sector 62, Greater Noida West, or anywhere nearby, Prakash Hospital Noida is a trusted name for labour, delivery and maternity care in Noida. Our obstetricians, midwives and neonatal team support you through every stage of labour and birth.

To book a consultation, call the number.

Sources: American College of Obstetricians and Gynecologists obstetric care consensus on safe prevention of the primary caesarean delivery and guidance on signs of labour; World Health Organization recommendations on intrapartum care. Duration ranges are typical and vary.

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